1. 2 Ethical and Legal Issues 2. Define the terms “law,” “ethics,” and “etiquette” Ethics help us make decisions at home, in the workplace, or in the community. In healthcare, ethics guide the people giving care. For example, keeping a resident’s information confidential is ethical behavior. It is also the law. In healthcare, laws protect those receiving care. For example, there is a law against stealing a resident’s belongings.

2. 2 Ethical and Legal Issues 2. Define the terms “law,” “ethics,” and “etiquette” Etiquette is the code of proper behavior and courtesy in a certain setting. For example, identify yourself when you answer the phone at your facility. Ask, “How may I help you?” This is proper telephone etiquette.

3. 2 Ethical and Legal Issues 3. Discuss examples of ethical and professional behavior Professional and ethical behavior is vital to the safety of residents. Remember the following guidelines for behavior that nursing assistants must follow: Keep all resident and staff information confidential. Be honest at all times. Be trustworthy. Do not accept gifts or tips. Report abuse or suspected abuse of residents.

4. 2 Ethical and Legal Issues 3. Discuss examples of ethical and professional behavior Remember the following guidelines for behavior that nursing assistants must follow (cont’d): Do not report to work under the influence of alcohol or drugs. Follow all facility policies, rules, and procedures. Do assigned tasks. Report mistakes promptly. Be positive, professional, and tactful. Treat all residents with respect and be empathetic. Be patient.

5. 2 Ethical and Legal Issues 4. Describe a nursing assistant code of ethics Many facilities have adopted a formal code of ethics. This helps their employees deal with issues of right and wrong. All facility codes of ethics revolve around the idea that the resident is a valuable person who deserves ethical care.

6. 2 Ethical and Legal Issues Transparency 2-1: Nursing Assistant Code of Ethics 1.I will strive to provide and maintain the highest quality of care for my residents. I will fully recognize and follow all of the Residents’ Rights. 2.I will communicate well, serve on committees, and read all material as provided and required by my employer. I will attend educational in-services, and join organizations relevant to nursing assistant care. 3.I will show a positive attitude toward my residents, their family members, staff, and other visitors. 4.I will always provide privacy for my residents. I will maintain confidentiality of resident, staff, and visitor information. 5.I will be trustworthy and honest in all dealings with residents, staff, and visitors.

7. 2 Ethical and Legal Issues Transparency 2-1: Nursing Assistant Code of Ethics (cont’d.) 6.I will strive to preserve resident safety. I will report mistakes I make, along with anything that I deem dangerous, to the right person(s). 7.I will have empathy for my residents, other staff, and all visitors, giving support and encouragement when needed. 8.I will respect all people, without regard to age, gender, ethnicity, religion, economic situation, sexual orientation, or diagnosis. 9.I will never abuse my residents in any way. I will always report any suspected abuse to the proper person immediately. 10.I will strive to have the utmost patience with all people at my facility.

8. 2 Ethical and Legal Issues 4. Describe a nursing assistant code of ethics Think about this question: Why is a code of ethics important for nursing assistants?

9. 2 Ethical and Legal Issues 5. Explain the Omnibus Budget Reconciliation Act (OBRA) The Omnibus Budget Reconciliation Act (OBRA) was passed in 1987. It has been updated many times since then. OBRA was written in response to reports of poor care and abuse in long-term care facilities. Congress decided to set minimum standards of care. This included standardizing training of nursing assistants.

10. 2 Ethical and Legal Issues 5. Explain the Omnibus Budget Reconciliation Act (OBRA) Think about these questions: Why would creating minimum standards for nursing assistant training be important? What kind of training/what topics could help prevent poor care and abuse of residents?

11. 2 Ethical and Legal Issues 5. Explain the Omnibus Budget Reconciliation Act (OBRA) OBRA requires that the Nurse Aide Training and Competency Evaluation Program (NATCEP) set minimum requirements for nursing assistants. Nursing assistants must complete at least 75 hours of training. However, programs may exceed these minimums. Many states require 80 to 150 program hours in theory and clinical skills.

12. 2 Ethical and Legal Issues 6. Explain Residents’ Rights REMEMBER: Be very familiar with Residents’ Rights. They are legal rights and understanding and respecting them is an important part of your job.

13. 2 Ethical and Legal Issues 6. Explain Residents’ Rights Residents’ Rights: Quality of life Services and activities to maintain a high level of wellness Be fully informed about rights and services Participate in their own care Make independent choices

14. 2 Ethical and Legal Issues 6. Explain Residents’ Rights Residents’ Rights (cont’d): Privacy and confidentiality Dignity, respect, and freedom Security of possessions Rights with transfers and discharges Right to complain Visits Rights with regard to social services

15. 2 Ethical and Legal Issues Handout 2-1: Decision Quiz Choices I have made today include: 1.__________________________________________ 2.__________________________________________ 3.__________________________________________ 4.__________________________________________ 5.__________________________________________ 6.__________________________________________

16. 2 Ethical and Legal Issues 7. Explain types of abuse and neglect Preventing abuse and neglect is a very important part of Residents’ Rights. In order to do this, it helps if you understand more about the different types of abuse and neglect.

17. 2 Ethical and Legal Issues 7. Explain types of abuse and neglect REMEMBER: You are legally required to report any observed or suspected abuse of residents and assist residents who wish to make a complaint of abuse in every way possible.

18. 2 Ethical and Legal Issues 8. Recognize signs and symptoms of abuse and neglect REMEMBER: As a nursing assistant, you are considered a mandated reporter.

19. 2 Ethical and Legal Issues 8. Recognize signs and symptoms of abuse and neglect Signs of physical abuse: Unexplained broken bones Unexplained bruising Similar injuries that occur repeatedly Burns shaped in specific ways Bite marks or scratches Unexplained weight loss or signs of dehydration

20. 2 Ethical and Legal Issues 8. Recognize signs and symptoms of abuse and neglect Signs of physical abuse (cont’d): Dry, cracked, torn or bleeding skin Missing hair Broken or missing teeth Blood in underwear Bruising in genital area

21. 2 Ethical and Legal Issues 8. Recognize signs and symptoms of abuse and neglect Signs of psychological abuse: Depression or withdrawal Mood swings Fear and anxiety, especially when a caregiver is present Lack of appetite Fear of being left alone

22. 2 Ethical and Legal Issues 8. Recognize signs and symptoms of abuse and neglect Signs of neglect: Sores on the body Weight loss, poor appetite, or signs of dehydration Frequent complaints of hunger or thirst Strong smell of urine Unclean body

23. 2 Ethical and Legal Issues 8. Recognize signs and symptoms of abuse and neglect Signs of neglect (cont’d): Dirty, matted, or unstyled hair Ragged or dirty fingernails Soiled clothes or bed linens or incontinence briefs not being changed Ripped or torn clothing Damaged or poorly fitting hearing aids, glasses, dentures Unanswered call lights

24. 2 Ethical and Legal Issues 8. Recognize signs and symptoms of abuse and neglect Other signs of abuse: Missed doctor appointments Changing doctors frequently Wearing makeup or sunglasses to hide injuries Family concern that abuse is occurring Person not taking medication Caregiver does not allow others to be alone with resident

25. 2 Ethical and Legal Issues Handout 2-2: Who is Vulnerable to Abuse and Neglect?

26. 2 Ethical and Legal Issues Handout 2-2: Who is Vulnerable to Abuse and Neglect? (cont’d.) Some people are more vulnerable to adult abuse or neglect than others. They include: Elderly Physically ill or disabled Developmentally disabled Mentally ill or disabled People with communication problems, such as hearing, speech, and vision All of these people have a few things in common that make them so vulnerable. They are often unable to stand up for themselves, or report abuse or neglect to others. They may not even understand that they have rights. Often these people can be much more demanding to care for, which increases the stress that caregivers have to deal with. Caregivers may not have been properly trained to care for these particular people, and they may not understand why these people behave the way they do. Caregivers may also be overworked, tired, stressed, and unappreciated, all while caring for someone who requires so much time and energy. These are the people who most need your help in protecting themselves. They may not be able to speak for themselves, but the signs of abuse and neglect may speak volumes for them, if you just know how to recognize these signs.

27. 2 Ethical and Legal Issues 9. Describe the steps taken if a nursing assistant is suspected of abuse REMEMBER: When a report of abuse by a nursing assistant is made, the NA is usually suspended immediately. The NATCEP (Nurse Aide Training and Competency Evaluation Program) is notified, as well as the facility administrator. Adult Protective Services (APS) may be notified.

28. 2 Ethical and Legal Issues The following steps are taken after a report of abuse by a nursing assistant: A full, confidential investigation is completed. The facility will protect the resident and the person who reported the abuse from retaliation. If the investigation does not prove the claim of abuse, the NA returns to work. If the investigation shows that there might be truth to the claim, specific actions are taken. 9. Describe the steps taken if a nursing assistant is suspected of abuse

29. 2 Ethical and Legal Issues These steps are outlined by NATCEP: Investigation Notification Hearing Decision of hearing Appeals process 9. Describe the steps taken if a nursing assistant is suspected of abuse

30. 2 Ethical and Legal Issues REMEMBER: If abuse is found to have occurred, the nursing assistant is placed on the abuse registry in addition to other possible penalties. Employers check this registry before hiring nursing assistants. 9. Describe the steps taken if a nursing assistant is suspected of abuse

31. 2 Ethical and Legal Issues 10. Discuss the ombudsman’s role The ombudsman visits the facility and listens to residents. He or she decides what course of action to take if there is a problem. An ombudsman can help settle disputes and resolve conflicts. He or she provides an ongoing presence in nursing homes to monitor care and conditions.

32. 2 Ethical and Legal Issues Typical duties of an ombudsman: Advocates for Residents’ Rights and quality care Educates consumers and care providers Investigates and resolves complaints Appears in court and/or legal hearings Gives information to the public 10. Discuss the ombudsman’s role

33. 2 Ethical and Legal Issues 11. Explain HIPAA and related terms Think about this question: What negative consequences could happen if you do not protect the privacy of residents’ information?

34. 2 Ethical and Legal Issues 11. Explain HIPAA and related terms REMEMBER: One of the most important parts of a nursing assistant’s job is to keep resident information confidential.

35. 2 Ethical and Legal Issues 11. Explain HIPAA and related terms The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996. This law sets standards for protecting the privacy of patients’ health information. It identifies certain protected health information (PHI) that must remain confidential.

36. 2 Ethical and Legal Issues 11. Explain HIPAA and related terms HITECH (Health Information Technology for Economic and Clinical Health) became law at the end of 2009. It is a way to expand the protection of electronic health records (EHR). The HITECH Act increases civil and criminal penalties for sharing PHI and expands the ability to enforce these penalties.

37. 2 Ethical and Legal Issues Remember these ways that NAs can keep PHI confidential: Do not give out health information on the phone except to approved staff members. Do not give personal information to visitors. Do not share medical records with anyone other than the care team. Do not discuss residents in public areas. Do not bring family or friends to the facility. 11. Explain HIPAA and related terms

38. 2 Ethical and Legal Issues Ways that NAs can keep PHI confidential (cont’d): Double-check fax numbers and use cover sheets. Return charts to proper place after use. Dispose of personal notes regarding resident care prior to leaving work for the day. Log out and exit web browser when finished with computer work. 11. Explain HIPAA and related terms

39. 2 Ethical and Legal Issues Ways that NAs can keep PHI confidential (cont’d): Do not include private information in e-mails. Do not share resident information on any social networking site (e.g., Facebook or Twitter). Do not takes photos of residents and share them with anyone, including via cell phones, e-mail, social networking sites, or other websites. Give documents found with resident’s information to the nurse. 11. Explain HIPAA and related terms

40. 2 Ethical and Legal Issues REMEMBER: There are serious penalties, including fines and even prison time, for not following HIPAA guidelines. 11. Explain HIPAA and related terms

41. 2 Ethical and Legal Issues The Patient Self-Determination Act (PSDA) is a federal law originally passed in 1990. The PSDA requires all healthcare agencies receiving Medicare and Medicaid money to give adults, during admission or enrollment, information about their rights relating to advance directives. 12. Discuss The Patient Self-Determination Act (PSDA) and advance directives

42. 2 Ethical and Legal Issues Think about this question: What are some examples of advance directives and why are they important? 12. Discuss The Patient Self-Determination Act (PSDA) and advance directives